European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial Comparative Study
Comparison of GlideScope video laryngoscope and intubating laryngeal mask airway with direct laryngoscopy for endotracheal intubation.
The aim of this study was to determine whether GlideScope video laryngoscope (GVL) and intubating laryngeal mask airway (i-LMA) improve the intubation success rate and could be easily learned and performed by paramedic students when compared with the direct laryngoscopic (DL) method. The study was designed as a prospective randomized crossover trial that included 121 paramedic students. All participants were asked to intubate each Ambu Airway Management Trainer manikins after the lecture and demonstration. ⋯ Success rates of i-LMA and GVL were significantly higher compared with DL (P=0.005 and P=0.006, respectively). No significant difference was determined between i-LMA and GVL in terms of successful intubation (P>0.05). This study showed that GVL and i-LMA provided better intubation success rates and were easier for paramedic students when compared with the classic DL method.
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Comparative Study
Predictive factors for positive coronary angiography in out-of-hospital cardiac arrest patients.
Coronary angiography is often performed in survivors of out-of-hospital cardiac arrest, but little is known about the factors predictive of a positive coronary angiography. Our aim was to determine these factors. ⋯ Among the factors identified, diabetes and a history of coronary artery were strong predictors for a positive coronary angiography, whereas ST segment elevation was not as predictive as expected.
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Comparative Study
Interrater agreement: a comparison between two emergency department triage scales.
The aim was to elucidate if, by strictly applying the Adaptive Process Triage (ADAPT) scale, the interrater agreement increased among the participating registered nurses (RNs) than when triaging according to the older scale, which allowed subjective interpretations of signs and symptoms. ⋯ Both the triage scales showed moderate overall agreements, while dispersion of triage decisions across several triage levels declined when ADAPT was used. Although the algorithm for acuity allocation by ADAPT seemed well defined, many patient scenarios were triaged as both unstable and stable and thus allocated to various triage levels. If ADAPT is to function as a safe triage tool with low interrater variability, further revision of the triage algorithms is needed.
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Comparative Study
Physician experience in addition to ACLS training does not significantly affect the outcome of prehospital cardiac arrest.
Little data exists on whether the physicians' skills in responding to cardiac arrest are fully developed after the advanced cardiac life support (ACLS) course, or if there is a significant improvement in their performance after an initial learning curve. ⋯ In this study, resuscitative experience of the physician did not have a significant effect on survival suggesting that experience does not significantly add to the current ACLS training in responding to ventricular fibrillation/ventricular tachycardia. More studies are needed.
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Comparative Study
The utility of shock index in differentiating major from minor injury.
The importance of early recognition of hemorrhagic shock and its effects on outcome have long been recognized. Traditional vital signs are relatively insensitive as early diagnostic markers of hemorrhage. The shock index (SI); heart rate (HR) divided by systolic blood pressure (SBP), has been suggested as such a marker. We tested the diagnostic utility of the SI in differentiating major from minor injury in trauma patients. ⋯ The SI can be a valuable tool, raising suspicion when it is abnormal even when other parameters are not, but is far too insensitive for use as a screening device to rule out disease. A normal SI should not lower the suspicion of major injury.